Complaint Investigation Report

On 07/20/2023, 2 staff members were interviewed regarding the allegation. Based on interview, the facility was only notified of this issue in June 2023 and acted immediately after. Notifications regarding R1's insurance were being sent to R1's responsible party. S1 stated that the facility provided a courtesy service to assist resident (R1) in filing their insurance paperwork every month. S1 states based on their contract this task is not the facility’s responsibility, but is the responsibility of either the resident and/or family.

It was stated that R1’s insurance paperwork was delayed for 6 months due to the need of an updated assessment from the insurance company. The Memory Care Director who would have been responsible for filing the insurance paperwork during these months does not currently work for the facility.

The review of records does not state a written agreement regarding the facility’s responsibility to file insurance paperwork for resident(s).

The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and a copy of the report was provided.